Making lower leg prostheses more accessible

After gaining her Master’s degree in International Relations and International Organizations, Merel Rumping did not become a diplomat after all but a social entrepreneur. ‘To do something about the injustice in the world.’ The University of Groningen elected her as the 2016 Alumnus of the Year. Rumping will receive her prize during the opening of the Academic Year on 4 September.

Sometimes Merel Rumping had to ride around Medellín on a scooter for two hours to reach her clients. This was in 2006. She was working for the micro-credit bank La Corporación Mundial de la Mujer, personally visiting the people who had applied for a loan. That took her to the suburbs of the metropolis in the north-west of Colombia.

She remembers a woman who earned money by selling children’s underwear. Her husband would cut the fabric, she would do the sewing. Until the sewing machine broke down. From that moment, the couple had to live on a diet of oranges from their own orange tree and eggs from the hens they owned. They almost died of starvation. Thanks to the loan, they could buy a new sewing machine.

Social enterprises

Eleven years have gone by since. The world of micro-credit is now far behind Merel Rumping, but Colombia is still fresh in her mind. She is seated at a Dutch patio table, on a springtime Tuesday, as the pollen from the trees fill the air. In front of her, a cappuccino cup and a glass of water, which she will be sliding across the table later on to visualize the business model of her social enterprise, LegBank.

Rumping came to Groningen in 2008 to pursue the a Master's degree in International Relations and International Organizations (IBIO). This programme promised to be a stepping stone for a later career as a diplomat. During her internship at the Dutch embassy in Morocco, however, she realized that this was not the life for her: as a diplomat, the distance between herself and the people she wanted to help would be too large. Distance had been not been a problem during her work at the micro-credit bank in Colombia. So after graduating from the University of Groningen, she decided to seek employment with ProPortion, an organization in Amsterdam that establishes social enterprises in emerging economies.

LegBank

Under the wings of ProPortion, Rumping initiated LegBank, her own social enterprise. During her time in Medellín, she had noticed that many Colombians had lost a leg, partly due to the large number of landmines left over from the decades of conflict between left-wing guerrillas, right- wing militias and the government. She established LegBank to ensure easy access to a good prosthesis for disabled people in developing countries, starting with Colombia.

‘Together with students from Delft University of Technology, I went to Colombia to identify the problems of people who need a prosthesis’, she explains. ‘On the one hand, at system level, distance was one of those problems: the orthopaedic centres are mainly in the cities, requiring people to travel long distances without knowing exactly where to go. On the other hand, at product level, we noticed that many people indeed had a prosthesis but had put it under their bed because it hurt. Even a 30,000 euro foot will still hurt if the sleeve connecting the prosthesis with the stub doesn't fit properly.’

Invention

An invention by Arjan Buis, a Dutch researcher at Strathclyde University in Glasgow, became crucial for LegBank. Buis had previously invented a medical device, the Majicast, that uses water pressure for quick and easy casting of plaster moulds, which seamlessly take the shape of someone's amputated limb. The mould is then used to produce a tight- fitting sleeve for the stub, making the prosthesis comfortable to wear.

The only problem was that Arjan Buis’ device could not simply be used on a large scale. It still required extensive testing and tinkering by a Dutch design agency, together with the prosthesis makers and researchers from Strathclyde. Rumping: ‘I am not an engineer, so at some point I wondered: “Are we still not ready? Do we have to test yet again?” It may sound simple: a closed water tank with a membrane in it, but it is a very complex product – one of its components has even been patented.’

Head Office Google

The financial situation was starting to become dire after the first year. ‘I had been working for a year and a half and had not yet found funding. There were some minor sources of money but not enough to keep everything running. And then, all of a sudden’ – Rumping snaps her fingers – ‘Google surfaced as the solution’. In early 2016 the Californian internet company invested a million dollars in Legbank. It took more than the snapping of fingers, though: it required an extensive application process, including countless proposals and multiple skype sessions with Google headquarters in San Francisco.

The investment rescued her project and is the reason that she can now slide her cup of cappuccino and glass of water across the patio table. Rumping illustrates the business model that is currently being tested in Colombia: ‘So, there is a large, full- fledged orthopaedic centre here (picks up the cappuccino cup). Everything is present there: the right means to make prostheses, trained staff. Then, there is a smaller centre here (moves the glass of water), where someone makes prostheses makes with fewer means. We have planned for this person to use the Majicast: (s)he plasters someone's stub, that person enters the device, they wait for five minutes and the mould is ready. They send it to the large orthopedic centre, where they make a prosthesis, which is delivered to the smaller centre. This is Legbank’s actual aim: to decentralize orthopaedic care. Legbank’s business model allows prosthesis makers to purchase the Majicast on credit. The same goes for the disabled and their prostheses.

Orthopaedic conference

Preparations are currently ongoing for the industrialized production of the Majicast. Ten devices have been pre-ordered, five of which will be shipped to Colombia in October. If all goes well there, Legbank can be introduced in other countries. At the beginning of May, Rumping attended an orthopaedic conference in Cape Town, South Africa, where she talked to specialists from Kenya. She also has her eye on South Africa and India as potential markets. ‘India is a country with a tremendously high rate of diabetes’, she says, ‘the number one cause of lower-leg amputation worldwide’.

It is not Merel Rumping's intention to take all the credit for LegBank. Although she is marketeer, project manager, executive and fundraiser all in one, she stresses that the team also includes researchers from Strathclyde University, prosthesis makers at Hoogstraat orthopaedic centre in Utrecht and her colleagues at ProPortion.

A vague dream

She grew up in Heemskerk in the province of North Holland. ‘I come from a socially engaged family’, she explains. ‘My mother is a nurse and my father works with children with learning disabilities.’ She chose the European Studies programme in Amsterdam but flew to Colombia after just a few months, at the age of 20, to do volunteer work with street children in a shelter in Medellín.

It all started with a vague dream: she had wanted to learn Spanish and happened to know someone she could stay with in Colombia. The reality awaiting her was harsh. ‘There are children who work in prostitution. I knew an eleven-year- old girl, whom I literally pulled away from under a blanket on the streets. She was prostituting herself to raise money for her brother of seven, Sebastian, who walked around in his underpants with a bottle of glue, high all the time. That was really a very tough world. Although I did have a lot of fun with those kids, I think my time there has shaped me profoundly – I discovered how violent the world is. You are not aware of this when you come from a village in the Netherlands. I would cycle to school along the meadows, cycle home, go to my dance classes. And all of a sudden, there I was, knee deep in the real world, seeing the injustice around me. That has challenged me to do something about it during my life.’

‘In retrospect, I see that my time there helped me establish a network in Colombia. I got to know people there who later on helped me meet with doctors, health insurance companies and government representatives. It has been exactly ten years since I lived there. It is awkward to return now, to a completely different world. I mean: I used to hang out with young people who were all a bit smelly and often had lice. Now I meet with government officials. Very odd.’

BIO Merel Rumping

Merel Rumping (1984) studied Political Science in Toulouse, received her Bachelor's degree in European Studies from the University of Amsterdam and graduated from the University of Groningen in 2010 with a Master's degree in International Relations and International Organizations. (Specialization: business ethics). Her Master's thesis was about the violent conflict about the coltan mines in Eastern Congo and the moral involvement of businesses. Coltan is an important raw material for mobile phones and game consoles. After her studies in Groningen, she worked at the Dutch embassy in Morocco, at Max Havelaar and at the Royal Bank of Scotland. Since 2011, she has been working for ProPortion, where she established the social enterprise LegBank. She defines social entrepreneurship as ‘entrepreneurship which aims to find solutions for societal problems’.

Text: Jurgen Tiekstra
Photo: Reyer Boxem
Source: Broerstraat 5, the alumni magazine of the University of Groningen